Foot Injuries

RICE

RICE stands for rest, ice, compression, and elevation. These are the four basic elements of immediate treatment for injuries to the feet.

Rest
—Rest your foot as soon as possible.

Ice
—Ice is important to reduce swelling and promote recovery during the first 48 hours. A bag or towel that contains ice should be wrapped around the injured area. This should be done on a repetitive cycle of 20 minutes on, 40 minutes off.
Do not put ice directly on the skin.

Compression
—An elastic bandage should be lightly wrapped around the area.

Elevation
—Use pillows to raise your foot above heart level.

Toe Pain

Corns

Removing Corns and Calluses
—To remove a corn or callus; soak it in very warm water for five minutes or more to soften the hardened tissue. Then, gently sand it with a pumice stone. Several such treatments may be necessary. Do not trim corns or calluses with a razor blade or other sharp tool. If the cutting instrument is not sterile, infection can result. It is also easy to slip and cut too deep, causing injury and bleeding.

Medicated Solutions and Pads
—There are a number of over-the-counter pads, plasters, and medications to remove corns and calluses. These treatments commonly contain salicylic acid. Salicylic acid may cause irritation, burns, or infections that are more serious than the corn or callus.

Use caution with these medications and self-treatment. You should see your doctor for treatment if you have:

Diabetes

Reduced feeling in your feet due to blood flow problems or nerve damage

Reduced flexibility or poor eyesight, which could impair your ability to use them properly

Ingrown Toenails

To relieve pain from ingrown toenails, try wearing sandals or open-toed shoes. Soak your toe for five minutes, twice a day. The water should be warm, but not hot. Seek professional treatment if you have diabetes or another condition that increases your risk of infection.

You can also apply antiseptic to a piece of cotton. Work the small wad of cotton under the nail. Get the cotton under the corner if possible, to lift the nail up. The cotton will also help force the toenail to grow out correctly. Change the cotton daily.

Bunions and Bursitis

You can relieve pressure and pain from
bunions
, bunionettes (involving the little toe), and
bursitis
by wearing appropriate shoes:

Soft, wide, low-heeled leather shoes that lace up

Athletic shoes with soft toe boxes

Open shoes or sandals with straps that don't touch the irritated area

A thick doughnut-shaped, moleskin pad can protect the area. In some cases, an orthotic can help take pressure off the bunion.

Hammertoes

At first, a
hammertoe
is flexible. You can usually relieve the pain by putting a toe pad into your shoe. Your shoes should have a deep, wide toe area. As the tendon becomes tighter and the toe stiffens, other treatments may be needed. These include exercises, splints, and custom-made shoe inserts called orthotics. Shoe inserts may help redistribute weight and ease the position of the toe.

Forefoot Pain

Neuromas

Roomier box-toe shoes and metatarsal pads may be helpful.

Stress Fracture

In most cases, stress fractures heal by themselves if difficult physical activities are avoided.

Sesamoiditis

Rest and reducing stress on the ball of the foot are the first lines of treatment for sesamoiditis.

Heel Pain

It is very important to have a correct diagnosis as to the exact cause of heel pain.

The American Orthopaedic Foot and Ankle Society (AOFAS) suggests shoe inserts, medications, and stretching of the Achilles tendon and calf muscles as the first line of therapy for heel pain.

If these treatments fail, you may need prescription heel orthotics and extended physical therapy.

Surgery is not recommended until nonsurgical methods have failed for at least six months and preferably up to 12 months.

Plantar Fasciitis

There are many different methods to help treat plantar fasciitis. Some treatment methods include:

Wearing proper shoes with a stiff heel and good arch support

Stretching exercises

Shoe inserts

Night splints

Taping the affected area

NSAIDs to relieve pain

Massage

Acupuncture

Corticosteroid injection

Surgery is not recommended until nonsurgical methods have failed for at least six months and preferably up to 12 months.

Haglund's Deformity (Pump Bump)

A pump bump is an inflammation of the bursa due to bony enlargement at the back of the heal. Treatment is aimed at reducing inflammation of the bursa. Treatment methods include:

NSAIDs

Apply ice to reduce swelling

Stretching exercises

Shoe inserts such as heel lifts and heel pads

Wearing shoes with a soft back or shoes that do not have a back

Orthotics, such as custom arch supports

Physical therapy

A cast

If these treatments are not effective, then surgery may be needed. Talk to your doctor about whether it is an option for you.

Tarsal Tunnel Syndrome

Pain from tarsal tunnel syndrome may sometimes be relieved with orthotics. Orthotics are specially designed shoe inserts that help redistribute weight to try to take pressure off the nerve.

Achilles Tendinopathy

Like most athletic injuries,
Achilles tendinopathy
should be treated as early as possible.
A tendinopathy may be a tendinitis or tendinosis. A tendinitis involves inflammation of the the tendon and a tendinosis does not. Although the term tendinitis is used most often, most tendinopathies do not have inflammation and are tendinosis.

Achilles Tendinitis

Rest is considered the first line treatment for achilles tendinopathy. Stretching and strengthening exercise are added after a period of rest.

If pain continues, surgery may be necessary.

Heel Spurs

Most heel spurs do not cause pain. They often show up when x-rays are taken. If there is pain, it is caused by the attachment of the plantar fascia to the heel bone causing the heel spur and the pain. With pain, insoles and NSAIDs may be helpful.

If the pain continues, surgery that involves cutting and releasing the plantar fascia and removing the spurs may be recommended. It is only used when other methods have failed.

Arch and Bottom-of-the-foot Pain

Flat Foot

Treatment for flat feet (often due to posterior tibial tendon dysfunction) involves pain relief and insoles or custom-made orthotics. Insoles and orthotics support the foot and prevent flat feet from getting worse.

In severe cases, surgery may be needed to provide long-term arch support, particularly if people want to be active.

Because of possible long-term problems, you should have flattened arches examined by a specialist.

Orthotics

A specialist may be needed for severe conditions, such as fallen arches or structural problems that cause imbalance. Podiatrists or physicians may need to fit and prescribe orthotics, or orthoses. These are insoles molded from a plaster cast of the patient's foot. Orthotics are usually categorized as rigid, soft, or semi-rigid.

When to Contact Your Doctor

Depending on your symptoms and your general health, experiment with shoe changes and over-the-counter products as long as you are making progress.

You should contact you doctor if you have persistent or progressive pain, or signs of an infection or arthritis.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.